Pearls of Glaucoma Management
JoAnn A. Giaconi
Simon K. Law
Anne L. Coleman
Joseph Caprioli (Eds.)
Pearls of Glaucoma
Management
JoAnn A. Giaconi
Simon K. Law
Dr. Anne L. Coleman
Dr. Joseph Caprioli
Jules Stein Eye Institute
100 Stein Plaza
Suite 2-118
Los Angeles, CA 90095
USA
Giaconi@jsei.ucla.edu
Law@jsei.ucla.edu
Coleman@jsei.ucla.edu
Caprioli@jsei.ucla.edu
ISBN: 978-3-540-68238-7 e-ISBN: 978-3-540-68240-0
DOI: 10.1007/978-3-540-68240-0
Springer Heidelberg Dordrecht London New York
Library of Congress Control Number: 2009926015
© Springer-Verlag Berlin Heidelberg 2010
This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilm or in any other way, and storage in data banks. Duplication of this publication or parts thereof is permitted only under the provisions of the German Copyright Law of September 9, 1965, in its current version, and permission for use must always be obtained from Springer. Violations are liable to prosecution under the German Copyright Law.
The use of general descriptive names, registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use.
Product liability: The publishers cannot guarantee the accuracy of any information about dosage and application contained in this book. In every individual case the user must check such information by consulting the relevant literature.
Cover design: eStudio Calamar, Figueres/Berlin
Printed on acid-free paper
Springer is part of Springer Science+Business Media (www.springer.com)
Foreword
If you have ever uttered the commonly expressed lament, “Glaucoma is so confusing!” then this text is for you. You will no longer be bewildered.
Why practitioners may be confused about how to be of help to patients with glaucoma – in its many incarnations and reincarnations – is easily understood. The issue seems to be overwhelming when one considers that the already massive population of those with glaucoma is increasing rapidly as the world’s population increases and ages.
During the past 50 years the fundamental definition of glaucoma has changed almost 180°, and the indications for treatment have become more variable and controversial, some advising early therapy and others strongly cautioning against such an approach: Various diagnostic tests have come and gone and are interpreted in such different ways that there seems to be no consensus; surgical techniques come in and out of fashion in perplexing ways. There seems to be a constantly shifting, sandy foundation on which are built unsteady schools of ever-varying advice. Why practitioners, patients, and the public are often bewildered is understandable.
The current text was designed to be relevant, scientific, and practical. The editors have accomplished their objective well. The authors chosen to share their wisdom are expert practitioners who recognize the dangers of basing treatment on theory. They, the leaders in their fields, create an understanding of glaucoma and conditions related to glaucoma that is sound, scientific, and effective. The editors clearly instructed their contributors to avoid speculation, to be practical, and to insist on evidence, not opinion (and where good evidence was lacking, to indicate such a lack). The result is a cohesive picture that should be of immense help to all those trying to make sense of what to many seems to be confusing.
It is perhaps not surprising that this text accomplishes its objective so admirably. The senior editor is a vastly experienced physician, equally at home in the clinic, the operating room, the classroom, and in a basic research laboratory. The contributing authors come from many different institutions and cultures; some are younger and others older. The current text, however, does not present information that must be sifted by a discerning reader in order to come up with appropriate advice. Rather, the authors simplify, clarify, organize, and explain practically and scientifically. Those wanting to know how to approach patients with glaucoma or those many, many patients in whom it is not clear whether glaucoma is present or not will find this a treasure trove of sound science blended with critical experience.
The need for this intellectually vigorous, practical approach to caring for patients with conditions related to intraocular pressure and optic nerve disease is great. There is probably truth in the belief that all persons will eventually develop glaucoma if they
v
vi |
Foreword |
|
|
live long enough. As the world population ages and increases, as resources become ever more precious, as cost considerations become more confining, there is increasing urgency for guidelines that concentrate on the essentials and that will help achieve the goal of caring for the sick and for the well, specifically, the greatest good for the greatest number, while still addressing the needs and wants of each individual person.
Currently there is much interest in “translational research.” This book is highly successful in translating vast amounts of disparate, sometimes disconcerting information into understandable sentences, paragraphs, and illustrations that will result in more effective and more relevant care.
Pennsylvania, USA |
George Spaeth |
Preface
This book was developed based on the questions that clinicians taking care of glaucoma patients, fellows, and residents have asked us as consultants. Most textbooks on glaucoma provide a broad overview of the basic science and clinical literature, which is very useful for students learning about glaucoma. However, these textbooks may leave many questions unanswered for the clinician specifically searching for advice on how to manage a specific problem. We have intentionally included topics that are not yet traditionally found in textbooks, such as new surgical technologies and measurement of optic nerve blood flow, because these and other areas are being discussed at meetings, and clinicians have specific questions about them.
In addition to asking the questions that frequently arise in managing patients with glaucoma, the goal of this textbook was to have the authors who are familiar with the world literature digest that information in the context of their own clinical experience. We asked authors to answer questions the way they might answer a physician’s questions over the phone. We asked them to state their opinions on how they like to manage clinical situations, where appropriate, but to also point out that their preferred management is not the only way to manage the problem if other acceptable means are available. The questions are organized by topic and cover diagnostic testing and interpretation, risk factors, medical treatment, procedural treatments, various glaucoma subtypes, and complications.
We must thank all the consulting physicians, students, residents, and fellows who we have encountered, and who inspired this text. Special thanks to Ms. Trini Phan who helped jump-start this project by sending out the invitations to contribute to our world-expert authors, and to Mr. Doug Hoffman whose technical assistance was invaluable.
Los Angeles, California, USA |
JoAnn A. Giaconi |
|
Simon K. Law |
|
Anne L. Coleman |
|
Joseph Caprioli |
vii
Contents
1 |
Optic Nerve: The Glaucomatous Optic Nerve . . . . . . . . . . |
1 |
|
|
1.1 |
Why is the Optic Nerve Important in the Diagnosis |
|
|
|
and Management of Glaucoma? . . . . . . . . . . . . . . |
1 |
|
References . . . . . . . . . . . . . . . . . . . . . . . . . |
10 |
|
2 |
Optic Nerve: Clinical Examination . . . . . . . . . . . . . . |
15 |
|
|
2.1 |
How Should I Examine the Optic Nerve? . . . . . . . . . . . |
15 |
|
2.2 |
How Does One Establish the Borders of the Nerve |
|
|
|
and Follow the Neuroretinal Rim Contour? . . . . . . . . . . |
17 |
|
2.3 |
How Does One Avoid Misinterpreting Rim Loss? . . . . . . . |
17 |
|
2.4 |
How Much Asymmetry Between Neuroretinal Rims |
|
|
|
and Nerves Is Important? . . . . . . . . . . . . . . . . . |
18 |
|
2.5 |
How Can I Estimate Disc Size and Compare Disc Size |
|
|
|
Between the Two Eyes? . . . . . . . . . . . . . . . . . |
18 |
|
2.6 |
How Quickly Can I Expect Optic Nerve Change to Occur? . . . . |
19 |
|
2.7 |
If I See a Disc Hemorrhage on Healthy Appearing Neuroretinal |
|
|
|
Rim, How Soon Can I Expect to See a Change in the Rim? . . . |
19 |
|
References . . . . . . . . . . . . . . . . . . . . . . . . . |
20 |
|
3 |
Optic Nerve: Heidelberg Retinal Tomography . . . . . . . . . |
23 |
|
|
3.1 |
What Indices Should I Use to Help Me Interpret |
|
|
|
the Heidelberg Retinal Tomograph (HRT) Printout? . . . . . . |
23 |
|
3.2 |
How Big a Change is Meaningful in the Numbers |
|
|
|
on an HRT Printout? . . . . . . . . . . . . . . . . . . . |
28 |
|
3.3 |
How Does the HRT Detect Progression? . . . . . . . . . . . |
29 |
3.4Can I Use the HRT Clinically to Diagnose Glaucoma and Glaucomatous Progression? How Certain Can I
|
|
Be that the Progression is Real? . . . . . . . . . . . . . . |
33 |
|
References . . . . . . . . . . . . . . . . . . . . . . . . . |
34 |
|
4 |
Optic Nerve: Scanning Laser Polarimetry . . . . . . . . . . . |
35 |
|
|
4.1 |
What is the Physical Principle Behind Scanning |
|
|
|
Laser Polarimetry (SLP)? . . . . . . . . . . . . . . . . . |
35 |
|
4.2 |
How is Image Quality and Artifact Assessed |
|
|
|
on the GDxVCC Printout? . . . . . . . . . . . . . . . . |
37 |
|
4.3 |
Can I Use the Scanning Laser Polarimetry Report |
|
|
|
to Diagnose Glaucoma? . . . . . . . . . . . . . . . . . |
38 |
ix
x |
|
|
Contents |
|
|
|
|
|
4.4 |
Can I Use Scanning Laser Polarimetry to Assess Progression |
|
|
|
of Optic Nerve Damage? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
40 |
|
References . . . . . . . . . . . . . . . . . . . . . . . . . |
42 |
|
5 |
Optic Nerve: Optical Coherence Tomography . . . . . . . . . . |
45 |
|
|
5.1 |
What Indices Should I Use to Help Me Interpret the OCT |
|
|
|
Optic Nerve Head Analysis Report? . . . . . . . . . . . . . |
45 |
|
5.2 |
What Indices Should I Use to Help Me Interpret the “RNFL |
|
|
|
Thickness Average Analysis Report” Printout? . . . . . . . . |
48 |
|
5.3 |
Can OCT Detect Progression? How Big a Change is Meaningful |
|
|
|
in the Numbers on an OCT Printout? . . . . . . . . . . . . |
49 |
|
5.4 |
Can I Use OCT Clinically to Diagnose Glaucoma? |
|
|
|
How Certain Can I Be that the Diagnosis is Real? . . . . . . . |
51 |
|
5.5 |
Should I Incorporate Spectral Domain-OCT into My Practice? . . |
52 |
|
References . . . . . . . . . . . . . . . . . . . . . . . . . |
53 |
|
6 |
Optic Nerve: Comparison of Technologies . . . . . . . . . . . |
55 |
|
|
6.1 |
Why Image the Optic Nerve? . . . . . . . . . . . . . . . |
55 |
6.2Is One Optic Nerve Imaging Technique Better or More Promising than the Others for Helping
|
|
to Detect Glaucoma and Its Progression? . . . . . . . . . . . |
60 |
|
6.3 |
Is One Imaging Technique Easier to Use and Interpret |
|
|
|
than Another? . . . . . . . . . . . . . . . . . . . . . |
61 |
|
6.4 |
How Often Should I Image the Nerve? . . . . . . . . . . . . |
61 |
|
References . . . . . . . . . . . . . . . . . . . . . . . . . |
61 |
|
7 |
Optic Nerve: Atypical Nerves and Nerve Findings . . . . . . . . |
63 |
|
|
7.1 Should Peripapillary Atrophy (PPA) Concern Me? |
|
|
|
|
Should it Be Followed for Enlargement? . . . . . . . . . . . |
63 |
|
7.2 |
In Examining Tilted Optic Discs, How Do I Distinguish |
|
|
|
Tilt vs. Glaucoma? . . . . . . . . . . . . . . . . . . . |
64 |
|
7.3 |
With Optic Nerve Head Drusen (OND), How Do I Tell |
|
|
|
If Visual Field Changes are due to Drusen vs. Glaucoma? . . . . |
67 |
|
7.4 |
What Differential Diagnosis Should Be Kept in Mind |
|
|
|
When Looking at a Case of Questionable Glaucoma? . . . . . . |
69 |
|
References . . . . . . . . . . . . . . . . . . . . . . . . . |
71 |
|
8 |
IOP: The Importance of Intraocular Pressure . . . . . . . . . . |
75 |
|
|
8.1 |
Why is Intraocular Pressure Important in Diagnosing |
|
|
|
and Treating Glaucoma? . . . . . . . . . . . . . . . . . |
75 |
|
References . . . . . . . . . . . . . . . . . . . . . . . . . |
78 |
|
9 |
IOP: Instruments to Measure IOP . . . . . . . . . . . . . . |
79 |
|
|
9.1 |
What is the Brief History of IOP Measurement? . . . . . . . . |
79 |
|
9.2 |
What Instrument(s) Most Accurately Measures IOP? . . . . . . |
80 |
9.3If Goldmann Applanation is not Available During an Exam Under Anesthesia, What Instrument is the Next Most Preferred
|
for IOP Measurement? . . . . . . . . . . . . . . . . . . |
83 |
9.4 |
In Cases of Corneal Transplants, Corneal Edema or Scarring, |
|
|
Which Instrument Would Be Best to Use to Obtain Accurate |
|
|
IOP Measurements? . . . . . . . . . . . . . . . . . . . |
84 |
9.5 |
In Cases of Prosthetic Corneas How Can I Measure the IOP? . . . |
84 |
Contents |
xi |
|
|
9.6Can I Convert the Readings of One Instrument
|
|
to Those of Another? . . . . . . . . . . . . . . . . . . |
84 |
|
References . . . . . . . . . . . . . . . . . . . . . . . . . |
84 |
|
10 |
IOP: Central Corneal Thickness . . . . . . . . . . . . . . . |
87 |
|
|
10.1 |
Why Has Central Corneal Thickness (CCT) Become So Important? |
87 |
|
10.2 |
How Does Central Corneal Thickness Vary? . . . . . . . . . |
88 |
|
10.3 |
Does CCT Predict Glaucoma? . . . . . . . . . . . . . . |
89 |
|
10.4 |
How Should I Use CCT in Clinical Practice? . . . . . . . . . |
90 |
|
References . . . . . . . . . . . . . . . . . . . . . . . . . |
92 |
|
11 |
IOP: Corneal Hysteresis . . . . . . . . . . . . . . . . . . . |
95 |
|
|
11.1 |
What is Corneal Hysteresis and How Does it Influence |
|
|
|
IOP Measurement? . . . . . . . . . . . . . . . . . . . |
95 |
|
11.2 |
What Are Typical Corneal Hysteresis Values? . . . . . . . . |
96 |
|
11.3 |
What Is the Relationship Between CCT, IOP, |
|
|
|
and Corneal Hysteresis? . . . . . . . . . . . . . . . . . . |
96 |
|
11.4 |
Should I Invest in Newer Devices to Measure IOP that Claim Less |
|
|
|
Influence of CCT? . . . . . . . . . . . . . . . . . . . |
97 |
|
References . . . . . . . . . . . . . . . . . . . . . . . . . |
98 |
|
12 |
IOP: Target Pressures . . . . . . . . . . . . . . . . . . . . |
99 |
|
|
12.1 |
Should I Establish a Target IOP on Every Patient? . . . . . . . |
99 |
|
12.2 |
If I Decide to Set a Target IOP, How Should I Set it – Do |
|
|
|
I Use a Percent Reduction or Aim Toward an Absolute Number? . |
99 |
|
12.3 |
How Should I Use Information About Diurnal IOP, Nocturnal |
|
|
|
Peaks, and Inter-Visit Fluctuation in Establishing a Target IOP? . |
101 |
12.4Are Supine and Nocturnal IOPs Important to Factor
into Target Pressure Estimation? . . . . . . . . . . . . . . 102
References . . . . . . . . . . . . . . . . . . . . . . . . . |
103 |
13 IOP: Fluctuation . . . . . . . . . . . . . . . . . . . . . . |
105 |
13.1 Why is IOP Fluctuation a Topic of Interest? . . . . . . . . . |
105 |
13.2What Factors Should Be Considered When Measuring
Short-Term IOP Fluctuation? . . . . . . . . . . . . . . . 106
13.3What is the Significance of Short-Term IOP Fluctuation? . . . . 106
13.4What Factors Should Be Considered in Measuring
Long-Term IOP Fluctuation? . . . . . . . . . . . . . . . 107
13.5What is the Significance of Measures of Long-Term
|
IOP Fluctuation? . . . . . . . . . . . . . . . . . . . . |
107 |
13.6 |
What is the Impact of Medication on Short-Term |
|
|
and Long-Term IOP Fluctuation? . . . . . . . . . . . . . |
108 |
13.7 |
What is the Impact of Surgery on Short-Term |
|
|
and Long-Term IOP Fluctuation? . . . . . . . . . . . . . |
109 |
13.8 |
How Aggressive Should I Be in Eliminating Long-Term |
|
|
IOP Fluctuation Given the Potential Complications |
|
|
of Medications and Surgery? . . . . . . . . . . . . . . . |
109 |
References . . . . . . . . . . . . . . . . . . . . . . . . . |
110 |
|
14 Gonioscopy: Why Do Indentation? . . . . . . . . . . . . . . |
113 |
|
14.1Which Patients Should have Gonioscopy? . . . . . . . . . . 113
14.2Of What Use is the Van Herick Angle Examination? . . . . . . 114
14.3 What Lens Should be Used for Gonioscopy? . . . . . . . . |
114 |
xii |
|
Contents |
|
|
|
14.4 |
How Do I Perform Indentation Gonioscopy? . . . . . . . . . |
115 |
14.5 |
What Should I Look for in the Angle? . . . . . . . . . . . |
117 |
14.6How Can I Recognize Peripheral Anterior Synechiae? . . . . . 118
14.7How Narrow is too Narrow? What are the Indications for Laser
|
Iridotomy in a Patient with No Symptoms of Angle-closure? . . |
118 |
14.8 |
What Should I Know about Plateau Iris? . . . . . . . . . . |
120 |
14.9 |
What Racial Differences Exist in Angle Anatomy? . . . . . . |
121 |
14.10Can Anterior Segment Imaging by Ultrasound Biomicroscopy
(UBM) or Anterior Segment OCT Replace Gonioscopy? . . . . 121
References . . . . . . . . . . . . . . . . . . . . . . . . . |
122 |
|
15 Visual Fields: Visual Field Test Strategies . . . . . . . . . . . |
123 |
|
15.1 What Are the Basic Differences Between Different |
|
|
|
Visual Field Machines and Tests? . . . . . . . . . . . . . |
123 |
15.2 |
What are the Theoretical Advantages of Different |
|
|
Test Strategies (SAP, SITA, FDT SWAP, etc)? . . . . . . . . |
125 |
15.3 Is There a Visual Field Program of Choice at This Point in Time? |
125 |
|
15.4 |
What Visual Field Program is Best for Use in a Glaucoma |
|
|
Subspecialty Clinic? . . . . . . . . . . . . . . . . . . |
125 |
15.5 |
What Program is Best for Use in a General Clinic to Screen |
|
|
for Glaucoma? . . . . . . . . . . . . . . . . . . . . . |
126 |
15.6 |
How Can I Convert from One Visual Field Strategy |
|
|
to Another to Help Me Interpret and Compare Tests? . . . . . |
127 |
15.7 |
What Can be Done to Obtain Visual Field Information |
|
|
in a Patient who Consistently Tests Unreliably? . . . . . . . |
127 |
References . . . . . . . . . . . . . . . . . . . . . . . . . |
128 |
|
16Visual Fields: Fluctuation and Progression . . . . . . . . . . . 129
16.1How Do I Distinguish Between Fluctuation and True
Progressive Change on Visual Field Printouts? . . . . . . . . 129
16.2How Frequently Should Visual Fields Be Tested? . . . . . . . 131
16.3What Are the Methods Available for Determining
Visual Field Progression? . . . . . . . . . . . . . . . . |
132 |
16.4 What Automated Progression Analysis Software Is |
|
Available to Help with Visual Field Interpretation? . . . . . . |
132 |
References . . . . . . . . . . . . . . . . . . . . . . . . . |
137 |
17 Visual Fields: Field Interpretation . . . . . . . . . . . . . . |
139 |
17.1How Is Information on a Single Field Printout
of the Humphrey Visual Field Analyzer Interpreted? . . . . . . 139
17.2How Is the Information on the Glaucoma Progression
Analysis Printout Interpreted? . . . . . . . . . . . . . . |
142 |
17.3What Are the Pitfalls to Avoid (or Commonly Made Mistakes)
in the Interpretation of Visual Fields? . . . . . . . . . . . . 146
References . . . . . . . . . . . . . . . . . . . . . . . . . 147
18 Other Tests in Glaucoma: Genetic Testing . . . . . . . . . . . |
149 |
|
18.1 |
What Genetic Tests are Currently Available to Test |
|
|
or Screen for Glaucoma? . . . . . . . . . . . . . . . . |
149 |
18.2 |
Are Genetic Tests for Glaucoma of Practical Use in a Clinical |
|
|
Setting Today, or Are They More of Theoretical Use? . . . . . |
151 |
Contents |
|
xiii |
|
|
|
18.3 |
How Do I Collect Samples and Where Do I Send Them |
|
|
for Analysis? . . . . . . . . . . . . . . . . . . . . . |
152 |
18.4 |
How Should the Results of Genetic Testing Be Interpreted |
|
|
for the Patient’s Use? . . . . . . . . . . . . . . . . . . |
153 |
References . . . . . . . . . . . . . . . . . . . . . . . . . |
155 |
|
19Other Testing in Glaucoma: Optic Nerve Blood Flow I . . . . . . 157 19.1 Should Optic Nerve Blood Flow Be Measured in Glaucoma
|
and Glaucoma Suspect Patients? . . . . . . . . . . . . . |
157 |
19.2 |
Is Abnormal Ocular Blood Flow Causal in Glaucoma |
|
|
and Glaucoma Progression, and Does It Correlate |
|
|
with Disease Severity? . . . . . . . . . . . . . . . . . |
158 |
19.3 |
Which Glaucoma Patients May Suffer from Ocular Blood |
|
|
Flow Impairment? . . . . . . . . . . . . . . . . . . . |
158 |
19.4What are the Most Common Techniques to Measure Optic
Nerve Blood Flow and what are Their Limitations? . . . . . . 160
References . . . . . . . . . . . . . . . . . . . . . . . . . 162
20 Other Tests in Glaucoma: Optic Nerve Blood Flow II . . . . . . |
165 |
20.1What Evidence Is There that Vascular Alterations Play
a Role in Open-Angle Glaucoma (OAG)? . . . . . . . . . . 165
20.2What Are the Positives and Negatives of Measuring
|
Optic Nerve Blood Flow? . . . . . . . . . . . . . . . . |
166 |
20.3 |
What Technologies Are Available to Measure |
|
|
Blood Flow Velocities? . . . . . . . . . . . . . . . . . |
166 |
20.4 |
Are There Examples of Ocular Hemodynamic Abnormalities |
|
|
Found in OAG Patients? . . . . . . . . . . . . . . . . . |
168 |
20.5How Are the Results of Blood Flow Measuring Devices Interpreted and Are There Limitations to These Blood
Flow Imaging Techniques? . . . . . . . . . . . . . . . . 170
20.6How Can the Data from Ocular Hemodynamic Studies
Be Used in Clinical Practice? . . . . . . . . . . . . . . . 172
References . . . . . . . . . . . . . . . . . . . . . . . . . 172
21Other Tests in Glaucoma: Multifocal Visual Evoked Potential . . . 175 21.1 What Is a Multifocal Visual Evoked Potential (mfVEP)? . . . . 175
21.2 |
How Do I Interpret the Results of mfVEP Tests? . . . . . . . |
177 |
21.3 |
Is the mfVEP a Useful Test in Glaucoma? . . . . . . . . . . |
179 |
References . . . . . . . . . . . . . . . . . . . . . . . . . |
180 |
|
22 Risk Factors . . . . . . . . . . . . . . . . . . . . . . . . 183
22.1When I Diagnose a Patient with Glaucoma for the First Time, What Can I Tell Him/Her About the Risk of Going Blind
|
from Glaucoma? . . . . . . . . . . . . . . . . . . . . |
183 |
22.2 |
What are the Main Risk Factors for Primary |
|
|
Open-Angle Glaucoma? . . . . . . . . . . . . . . . . . |
184 |
22.3 |
Is the Myopic Population at Higher Risk of Glaucoma? |
|
|
Do Myopic Patients with Glaucoma Progress Differently |
|
|
than Other Patients? . . . . . . . . . . . . . . . . . . |
187 |
References . . . . . . . . . . . . . . . . . . . . . . . . . |
187 |
|
xiv |
|
Contents |
|
|
|
23 Risk Factors: The Risk Calculator . . . . . . . . . . . . . . |
191 |
|
23.1 |
Is a Risk Calculator Useful? . . . . . . . . . . . . . . . |
191 |
23.2 |
How Should I Use a Risk Calculator? . . . . . . . . . . . |
192 |
23.3Can I Screen for Glaucoma with a Risk Calculator? . . . . . . 193
23.4What Does It Mean to Me and My Patient
If the Risk Score Is High? . . . . . . . . . . . . . . . . |
193 |
References . . . . . . . . . . . . . . . . . . . . . . . . . |
194 |
24 Medical Treatment: First Line Agents and Monotherapy . . . . . |
195 |
24.1 Should Beta Blockers Still Be Used as a First-Line Agent? . . . |
195 |
24.2If a Single Agent Does Not Provide Adequate IOP Lowering, Is It Better to Switch to Another Medication in the Same Class
or to Another Class, or Is It Better to Add a Second Medication? . 198
24.3When Combining Topical Medications, Do Certain Combinations Work Better Together than Others, i.e., What Should I First
Add to a Prostaglandin Analog or to a Beta Blocker? . . . . . |
199 |
24.4 Should Miotics Still Be Used? . . . . . . . . . . . . . . |
200 |
References . . . . . . . . . . . . . . . . . . . . . . . . . |
200 |
25 Medical Treatment: The Pregnant and Nursing Woman . . . . . |
203 |
25.1Which Glaucoma Medications Are Safe to Use in Pregnancy? . . 203
25.2What Medications Are Safe to Use in a Nursing Mother? . . . . 204 References . . . . . . . . . . . . . . . . . . . . . . . . . 205
26Medical Treatment: Carbonic Anhydrase Inhibitors . . . . . . . 207 26.1 Are Oral Carbonic Anhydrase Inhibitors (CAIs) Still to Be Used
Now that There Are Numerous Effective Topical Medications? . |
207 |
26.2How Should Oral CAIs Be Dosed? . . . . . . . . . . . . . . . . . . . . . . . . . 207
26.3What Are the Toxic Effects of Systemic CAIs? . . . . . . . . 208
26.4Can CAIs Be Used in Pregnant Women or Pediatric Patients? . . 209
26.5Can CAIs Be Used in Patients with Sickle Cell Anemia? . . . . 210
26.6 |
How Does Acetazolamide Differ from Methazolamide? . . . . |
210 |
26.7 |
Are Systemic and Topical CAI Effects Additive? . . . . . . . |
211 |
References . . . . . . . . . . . . . . . . . . . . . . . . . |
211 |
|
27Medical Treatment: Osmotic Agents . . . . . . . . . . . . . . 213
27.1When Using Hyperosmotics Agents, What Is a Typical Dose
for Acutely Elevated Intraocular Pressure (IOP)? . . . . . . . 213
27.2What Systemic History Should I Gather Prior to Administering
Hyperosmotic Agents? . . . . . . . . . . . . . . . . . |
216 |
27.3Should Hyperosmotic Agents Be Used to Lower IOP
Prior to Surgery? . . . . . . . . . . . . . . . . . . . . 216
References . . . . . . . . . . . . . . . . . . . . . . . . . 217
28 Medical Treatment: Neuroprotection . . . . . . . . . . . . . |
219 |
|
28.1 |
What Exactly Is Neuroprotection? . . . . . . . . . . . . . |
219 |
28.2 |
What Is the Basis of Neuroprotection? . . . . . . . . . . . |
220 |
28.3 |
What Medications Are Neuroprotective? . . . . . . . . . . |
221 |
28.4 |
Is There a Clinical Role for Systemic Medications |
|
|
in the Treatment of Glaucoma? . . . . . . . . . . . . . . |
223 |
References . . . . . . . . . . . . . . . . . . . . . . . . . |
223 |
|
Contents |
|
xv |
|
|
|
29 Medical Treatment: Treated vs. Untreated Glaucoma |
|
|
and Ocular Hypertension . . . . . . . . . . . . . . . . . . |
225 |
|
29.1 |
What Is the Natural History of Treated and Untreated |
|
|
Glaucoma and Ocular Hypertension? . . . . . . . . . . . . |
225 |
29.2 |
What Is the Natural History of Treated and Untreated Glaucoma? . |
226 |
29.3 |
What Is the Natural History of Untreated vs. Treated |
|
|
Ocular Hypertension? . . . . . . . . . . . . . . . . . . |
229 |
References . . . . . . . . . . . . . . . . . . . . . . . . . |
230 |
|
30 Medical Treatment: Adherence and Persistence . . . . . . . . . |
231 |
|
30.1 |
What Issues Are at Work in Patient Noncompliance? . . . . . |
231 |
30.2 |
How Can One Help Patients to Be More Compliant |
|
|
with Treatment? . . . . . . . . . . . . . . . . . . . . |
233 |
30.3 |
How Can One Educate Patients to Realize the Long-Term |
|
|
Impact of Glaucoma and Encourage Adherence? . . . . . . . |
234 |
References . . . . . . . . . . . . . . . . . . . . . . . . . |
236 |
|
31Medical Treatment: Alternative Medicine and Glaucoma . . . . . 237
31.1Is There Anything the Patient Can Do to Improve the Outcome of Their Disease Besides Using Conventional Treatments
(Medications and Surgery)? . . . . . . . . . . . . . . . |
237 |
31.2 When a Patient Asks About the Effect of Lifestyle on Glaucoma, |
|
How Can I Answer this with Regard to Exercise, Smoking, |
|
Alcohol, and Diet? . . . . . . . . . . . . . . . . . . . |
239 |
31.3How Should I Counsel Patients Who Inquire Regarding to Alternative and Complementary Therapy, Specifically
Marijuana Use, Gingko Biloba, Bilberry, and Acupuncture? . . . 241
References . . . . . . . . . . . . . . . . . . . . . . . . . 243
32Procedural Treatments: Laser Trabeculoplasty . . . . . . . . . . . . . . . . . . 247
32.1Should Laser Trabeculoplasty or Medication Be Used as First-Line Treatment? How Can Trabeculoplasty Be
|
Used as Adjunctive or Replacement Treatment? . . . . . . . |
247 |
32.2 |
Is There Still a Place for ALT Given the Availability of SLT? |
|
|
(In Other Words, as a Practitioner Should One Invest |
|
|
in Buying an SLT Laser?) . . . . . . . . . . . . . . . . |
249 |
32.3 |
When Should SLT or ALT not Be Performed? . . . . . . . . |
251 |
32.4 |
What are the Laser Settings and Techniques for ALT and SLT? . |
251 |
32.5What Pearls are There for Performing ALT and SLT? . . . . . 252
32.6What Complications Can I Expect and How Do I Deal with Them? How Frequently Should a Patient Be
Seen in Follow-Up After Trabeculoplasty? . . . . . . . . . |
253 |
32.7What is the Mechanism of Action of ALT and SLT? . . . . . . 254
32.8What Newer Laser Trabeculoplasty Modalities
are on the Treatment Horizon? . . . . . . . . . . . . . . 254
References . . . . . . . . . . . . . . . . . . . . . . . . . 255
33Procedural Treatments: Endoscopic Cyclophotocoagulation . . . . 257 33.1 When Can or Should Endoscopic Cyclophotocoagulation
(ECP) Be Used? . . . . . . . . . . . . . . . . . . . . |
257 |
33.2 Should ECP Be Used as a Primary Surgery for Glaucoma? . . . |
258 |
xvi |
Contents |
|
|
33.3 Is Burning the Ciliary Processes a Safe Thing to Do? . . . . . |
258 |
33.4Technically, How Is ECP Performed? . . . . . . . . . . . . 259
33.5How Is the Postoperative Course of ECP Managed? . . . . . . 260
33.6What Are Complications that May Be Encountered
|
and How Are They Specifically Managed? . . . . . . . . . |
261 |
33.7 |
When Can I Expect the Pressure Drop to Occur? . . . . . . . |
261 |
33.8 |
What Is the Long Term Safety Data on this Procedure? . . . . . |
261 |
References . . . . . . . . . . . . . . . . . . . . . . . . . |
262 |
|
34 Procedural Treatments: Transcleral Cyclophotocoagulation . . . . |
263 |
|
34.1 |
What is Transscleral Cyclophotocoagulation (TCP)? . . . . . |
263 |
34.2 |
When Should I Use TCP? Should it be Used as a Primary |
|
|
Surgery for Glaucoma? . . . . . . . . . . . . . . . . . |
264 |
34.3Technically, How is TCP Performed? . . . . . . . . . . . . 264
34.4How Should One Manage the Postoperative Course? When Can One Expect the Pressure to Drop After TCP?
When Can Medications be Tapered off After TCP? . . . . . . 266
34.5What Complications May be Encountered and How Can I Specifically Manage Each One? What is the Long-Term
Efficacy and Safety Data on TCP? . . . . . . . . . . . . . 266
References . . . . . . . . . . . . . . . . . . . . . . . . . 267
35Procedural Treatments: Trabeculectomy . . . . . . . . . . . . 271
35.1Is a Limbus-Based Trabeculectomy Better than a Fornix-Based Trabeculectomy? . . . . . . . . . . . . . . . . . . . . 271
35.2Should Antimetabolites be Used in All Cases of Trabeculectomy? . 272
35.3Do You Adjust Antimetabolite Usage and Dose Based
on Patient Age or Race? . . . . . . . . . . . . . . . . . 273
35.4What Different Techniques Can I Utilize to Apply Mitomycin-C? . 274
35.5Intraoperatively, What Can I Technically Do to Ensure
the Best Surgical Outcome? . . . . . . . . . . . . . . . |
275 |
35.6When Should I Use Adjustable Sutures? When Should I
Use Laser Suture Lysis? . . . . . . . . . . . . . . . . . 276
References . . . . . . . . . . . . . . . . . . . . . . . . |
277 |
36Procedural Treatments: Perioperative Medication . . . . . . . . 279
36.1Should Topical Glaucoma Medication Be Discontinued
Before Performing Trabeculectomy? . . . . . . . . . . . . 279
36.2What Preoperative and Postoperative Medications Are Needed for Trabeculectomy? How Long Should I Continue Topical
Steroid and Antibiotics After Glaucoma Surgery? . . . . . . . 280
36.3Which Topical Steroid Should Be Used Perioperatively? . . . . 281
36.4If IOP Reduction Is Needed Following Glaucoma Surgery, What Topical Medication Is Most Effective in Lowering IOP and Safest for the Trabeculectomy? Are Prostaglandins Effective
in IOP Reduction After Glaucoma Surgery? . . . . . . . . . 281
36.5How Should Anticoagulation and Antiplatelet Therapies
Be Managed Perioperatively? . . . . . . . . . . . . . . . 282
36.6Should Glaucoma Surgery Technique Be Modified to Reduce
the Chances of Hemorrhagic Complications? . . . . . . . . . 283
References . . . . . . . . . . . . . . . . . . . . . . . . . 284
Contents |
|
|
xvii |
|
|
|
|
37 |
Procedural Treatments: Bleb Needling . . . . . . . . . . . . . |
285 |
|
|
37.1 |
What Are the Different Techniques to Needle a Bleb? . . . . . |
285 |
|
37.2 |
Is It Ever Too Early or Too Late to Needle a Bleb? . . . . . . |
289 |
|
37.3 |
Are There Any Limits on How Often I Can Perform Needling |
|
|
|
and Injection of Antimetabolite? Should Antimetabolite Always |
|
|
|
Be Injected with Needling Procedures? . . . . . . . . . . . |
290 |
|
37.4 |
What Complications Should I Anticipate After Needling? . . . |
290 |
|
37.5 |
Is It Better to Needle or Reoperate on a Failing Bleb? . . . . . |
290 |
|
References . . . . . . . . . . . . . . . . . . . . . . . . . |
291 |
|
38 |
Procedural Treatments: Glaucoma Drainage Devices . . . . . . . |
293 |
|
|
38.1 |
Is One Tube Shunt Design Better than Another at Lowering IOP? |
293 |
|
38.2 |
Are There Certain Circumstances/Diagnoses Where One Type |
|
|
|
of Shunt May Be Preferred Over Another? . . . . . . . . . |
296 |
|
38.3 |
What Kind of IOP Results Can I Expect with a Tube Implant? . . |
297 |
|
38.4 |
What Are the Differences in Postoperative Course Between |
|
|
|
a Valved and Nonvalved Tube Shunt? . . . . . . . . . . . . |
297 |
|
38.5 |
What Can I Do If the Conjunctiva Will Not Close and Cover |
|
|
|
the Tube-Shunt as I am Finishing the Surgery? . . . . . . . . |
298 |
|
38.6 |
Should My Surgical Technique Change If the Eye Is Aphakic? . . |
299 |
|
38.7 |
Should Technique Change If the Patient Has a Great Deal of PAS? |
299 |
|
References . . . . . . . . . . . . . . . . . . . . . . . . . |
300 |
|
39 |
Procedural Treatments: New Surgical Options . . . . . . . . . |
301 |
|
|
39.1 |
What New Technologies or Surgical Options Have Emerged |
|
|
|
for the Treatment of Intraocular Pressure (IOP) in Glaucoma? |
|
|
|
Is One of the New Technologies More Promising than the Others? |
|
|
|
If So, What Is the Evidence? . . . . . . . . . . . . . . . |
301 |
|
References . . . . . . . . . . . . . . . . . . . . . . . . . |
306 |
|
40 |
Procedural Treatments: Ex-PRESS Mini Glaucoma Shunt . . . . |
307 |
|
|
40.1 |
How Often Is the Ex-PRESS Mini-Shunt Being Used in Place |
|
|
|
of More Traditional Glaucoma Surgery? Have Glaucoma |
|
|
|
Specialists Adopted this Surgery? . . . . . . . . . . . . . . . . . . . . . . . . . . |
307 |
|
40.2 |
What Is the Ex-PRESS Mini-Shunt and How Does It Work? . . |
307 |
|
40.3 |
What Are the Ex-PRESS Mini-Shunt’s Dimensions? |
|
|
|
How Is It Implanted? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
309 |
|
40.4 |
Should An Ex-PRESS Mini-Shunt Procedure Be Performed |
|
|
|
in Place of a Trabeculectomy? . . . . . . . . . . . . . . |
311 |
|
40.5 |
How Does Surgical Technique Differ Between an Ex-PRESS |
|
|
|
Shunt Procedure and a Trabeculectomy, and What Can Be |
|
|
|
Done to Obtain Better Outcomes with the Procedure? . . . . . |
313 |
|
40.6 |
What Complications Are Specific to the Ex-PRESS |
|
|
|
Shunt Procedure? . . . . . . . . . . . . . . . . . . . |
314 |
|
References . . . . . . . . . . . . . . . . . . . . . . . . . |
314 |
|
41 |
Procedural Treatments: Phacotrabeculectomy . . . . . . . . . |
317 |
|
|
41.1 |
Under What Circumstances Should a Combined |
|
|
|
Phacotrabeculectomy Be Performed? . . . . . . . . . . . . |
317 |
|
41.2 |
Under What Circumstances Should a Phacotrabeculectomy |
|
|
|
Not Be Performed? . . . . . . . . . . . . . . . . . . . |
319 |
xviii |
Contents |
|
|
41.3How Is the Postoperative Course of a Phacotrabeculectomy
Different than that After the Individual Surgeries? . . . . . . . 319
References . . . . . . . . . . . . . . . . . . . . . . . . . 320
42 Procedural Treatments: Surgery in End-Stage Glaucoma . . . . . |
323 |
|
42.1 |
What Is End-Stage Glaucoma? . . . . . . . . . . . . . . |
323 |
42.2 |
Should I Operate on a Patient with End-Stage Glaucoma? . . . |
324 |
42.3 |
What Is the Risk of Losing Remaining Vision from a Surgical |
|
|
Procedure in End-Stage Glaucoma Eyes? . . . . . . . . . . |
325 |
42.4How Do Specific Complications of Surgery in End-Stage
Glaucoma Lead to Vision Loss? . . . . . . . . . . . . . . 326
42.5What Can Be Done to Minimize Potential Vision Loss
Due to Surgery in End-Stage Glaucoma? . . . . . . . . . . |
327 |
References . . . . . . . . . . . . . . . . . . . . . . . . . |
327 |
43Glaucomas: Managing Normal-Tension Glaucoma . . . . . . . . 331 43.1 How Low an Intraocular Pressure Do I Need to Target
|
in Normal-Tension Glaucoma? . . . . . . . . . . . . . . |
331 |
43.2 |
If a Patient with Normal Tension Glaucoma Is Started on Topical |
|
|
Medication and the Intraocular Pressure Is Lowered 1–2 mmHg, |
|
|
Can I Consider that to Be Adequate Treatment? . . . . . . . |
332 |
43.3 |
What Is the Treatment of Choice in Normal-Tension |
|
|
Glaucoma – Medication, Laser, or Surgery? . . . . . . . . . |
334 |
43.4What Time Course of Progression Can I Expect in Normal-Tension Glaucoma Patients and Can I Predict
Who May Progress Over the Short Term? . . . . . . . . . . 334
References . . . . . . . . . . . . . . . . . . . . . . . . . |
336 |
44 Glaucomas: Pseudoexfoliation Glaucoma . . . . . . . . . . . |
337 |
44.1 Is There a Gene for Pseudoexfoliation Syndrome? . . . . . . |
337 |
44.2Is Pseudoexfoliation Associated with Systemic Disease? . . . . 337
44.3What Is the Risk of Developing Glaucoma Once PXF Material
Is Observed in the Eye? . . . . . . . . . . . . . . . . . |
338 |
44.4 What Are Surgical Considerations and Management Issues |
|
in Cataract Surgery Associated with Pseudoexfoliation? . . . . |
339 |
References . . . . . . . . . . . . . . . . . . . . . . . . . |
341 |
45 Glaucomas: Pigment Dispersion Glaucoma and Angle |
|
Recession Glaucoma . . . . . . . . . . . . . . . . . . . . |
345 |
45.1How Does Glaucoma in Pigment Dispersion Syndrome Differ Clinically from Other Glaucomas? . . . . . . . . . . . . . 345
45.2Is PDG Managed Differently than Primary Open Angle Glaucoma? . 347
45.3Is Laser Iridotomy Recommended in PDS/PDG Patients? . . . . 348
45.4What Problems Should Be Anticipated in PDS/PDG?
What Kind of Outcomes Can Be Expected in These Patients? . . . . 348
45.5How Does Glaucoma in Angle Recession Differ
|
from Other Glaucomas? . . . . . . . . . . . . . . . . . |
349 |
45.6 |
What Are the Expected Medical, Laser, and Surgical |
|
|
Treatment Outcomes in Angle Recession Glaucoma? . . . . . |
351 |
45.7 |
What Problems Should Be Anticipated in Patients |
|
|
with Angle Recession? . . . . . . . . . . . . . . . . . |
352 |
References . . . . . . . . . . . . . . . . . . . . . . . . . |
352 |
|
Contents |
|
|
xix |
|
|
|
|
46 |
Glaucomas: Sturge Weber Syndrome . . . . . . . . . . . . . |
355 |
|
|
46.1 |
How Does Glaucoma in Sturge-Weber Syndrome (SWS) |
|
|
|
Differ Clinically from Other Glaucomas? . . . . . . . . . . |
355 |
|
46.2 |
Is Management of Glaucoma in SWS Different from the Typical |
|
|
|
Management of Primary Open Angle Glaucoma (POAG)? . . . |
357 |
|
46.3 |
What Problems Should Be Anticipated in the Management |
|
|
|
of SWS Glaucoma? . . . . . . . . . . . . . . . . . . . |
359 |
|
46.4 |
What Kind of Outcomes Can Be Expected |
|
|
|
in this Type of Glaucoma? . . . . . . . . . . . . . . . . |
360 |
|
References . . . . . . . . . . . . . . . . . . . . . . . . . |
360 |
|
47 |
Glaucomas: Glaucoma and the Cornea . . . . . . . . . . . . |
363 |
|
|
47.1 |
How Do Glaucoma and IOP Affect the Cornea? . . . . . . . |
363 |
|
47.2 |
What Effect Do Topical Medications Have on the Corneal |
|
|
|
Endothelium and Epithelium? . . . . . . . . . . . . . . . |
364 |
|
47.3 |
What Effect Does Laser Glaucoma Surgery Have on the Cornea? . |
365 |
|
47.4 |
What Effect Does Incisional Glaucoma Surgery |
|
|
|
Have on the Cornea? . . . . . . . . . . . . . . . . . . |
366 |
|
47.5 |
How Do Corneal Diseases Affect Glaucoma? . . . . . . . . |
367 |
|
References . . . . . . . . . . . . . . . . . . . . . . . . . |
368 |
|
48 |
Glaucomas: Uveitic Glaucoma . . . . . . . . . . . . . . . . |
371 |
|
|
48.1 How Often Does One See Glaucoma as a Consequence of Uveitis? |
371 |
|
|
48.2 |
Is There a Way to Distinguish Between Elevated IOP |
|
|
|
Due to a Steroid Response vs. Uveitis? . . . . . . . . . . . |
372 |
|
48.3 |
How Do Inflammation and Steroids Cause an Increase in IOP? . |
373 |
|
48.4 |
When Should I Operate on Uveitic Glaucoma? . . . . . . . . |
374 |
|
48.5 |
Is There a Preferred Surgery for Uveitic Glaucoma |
|
|
|
(Trabeculectomy vs. Tube vs. Laser)? . . . . . . . . . . . |
374 |
|
48.6 |
Is One Tube Preferred over Another in Uveitic Glaucoma? . . . |
375 |
|
48.7 |
Do Prostaglandin Analogues Worsen Uveitic Inflammation? . . |
376 |
|
48.8 |
Can One Expect a Greater Inflammatory Response in Uveitics |
|
|
|
After Glaucoma Surgery? . . . . . . . . . . . . . . . . |
377 |
|
References . . . . . . . . . . . . . . . . . . . . . . . . . |
377 |
|
49Glaucomas: Neovascular Glaucoma . . . . . . . . . . . . . . 379 49.1 What Medications Can Be Used to Control
Neovascular Glaucoma? . . . . . . . . . . . . . . . . . 379
49.2What Is the Surgical Treatment of Choice for Neovascular Glaucoma? Should Everyone Always Get a Tube Shunt
to Control IOP, i.e., Can a Trabeculectomy Be Useful? . . . . . 381
49.3 How Should PRP and Glaucoma Surgery Be Timed? . . . . . 384
49.4Is Bevacizumab Useful in Neovascular Glaucoma?
What Kind of Results and Time-Course Can I Expect from
Its Use? For NV of the Iris, Should It Be Injected
into the Anterior Chamber or Vitreal Cavity? . . . . . . . . . 384 References . . . . . . . . . . . . . . . . . . . . . . . . . 386
50 Pediatric Glaucoma: IOP, Axial Length, and Surgery Indications . |
389 |
|
50.1 |
What Is the Best Way to Measure IOP in the Pediatric Patient? . |
389 |
50.2 |
Is One Instrument Better than Another for Measuring IOP |
|
|
in the Pediatric Age Group? . . . . . . . . . . . . . . . |
391 |
xx |
Contents |
|
|
50.3 How Is Axial Length Measurement Used in Pediatric Glaucoma? |
391 |
50.4When Should Surgery Be Performed in Congenital Glaucoma, in Juvenile-Onset Glaucoma, and in Secondary Type Pediatric Glaucomas? What Factors Help Me Decide
Which Procedure to Perform? . . . . . . . . . . . . . . . 392
References . . . . . . . . . . . . . . . . . . . . . . . . . 395
51 Pediatric Glaucoma: Glaucoma Medications and Steroids . . . . |
397 |
51.1Which Glaucoma Medications Can Be Used Safely in the Pediatric Population and How Are Medication Side Effects
in the Pediatric Population Different than in Adults? . . . . . . 397
51.2Do Topical Steroids Induce a Different Steroid Response
in Children? . . . . . . . . . . . . . . . . . . . . . . 400 References . . . . . . . . . . . . . . . . . . . . . . . . . 401
52 Pediatric Glaucoma: Angle Surgery and Glaucoma
Drainage Devices . . . . . . . . . . . . . . . . . . . . . . 403
52.1How Do I Perform Goniosurgery? . . . . . . . . . . . . . 403
52.2How Do I Peform Glaucoma Drainage Devices
(GDD) in Children? . . . . . . . . . . . . . . . . . . |
406 |
References . . . . . . . . . . . . . . . . . . . . . . . . . |
408 |
53 Pediatric Glaucoma: Trabeculectomy and Glaucoma |
|
Drainage Devices . . . . . . . . . . . . . . . . . . . . . . |
409 |
53.1Is Trabeculectomy the Preferred Surgery in Children Following
Angle Surgery (Goniotomy and Trabeculotomy)? . . . . . . . 409
53.2Is Trabeculectomy Preferred over Tube Shunt Surgery in Children? . 410
53.3Is There an Age Cut-Off for Performing Trabeculectomy
in the Pediatric Age Group? . . . . . . . . . . . . . . . |
410 |
53.4What Factors Help One Decide for or Against
One Surgery over the Other? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 411
53.5What Complications and Issues Should Be Anticipated
|
|
in the Intraoperative and Postoperative Periods? . . . . . . . |
411 |
|
53.6 |
What Can Be Done Technically to Perform a Better |
|
|
|
Trabeculectomy in Kids? . . . . . . . . . . . . . . . . |
412 |
|
53.7 |
What Can Be Done Technically to Perform a Better |
|
|
|
Glaucoma Drainage Device Surgery in Kids? . . . . . . . . |
413 |
|
References . . . . . . . . . . . . . . . . . . . . . . . . . |
414 |
|
54 |
Angle-Closure Glaucoma: Risk Factors . . . . . . . . . . . . |
415 |
|
|
54.1 |
Who Is at Risk for Acute Angle-Closure? . . . . . . . . . . |
415 |
|
54.2 |
Can I Predict Who Will Have an Angle-Closure Attack? . . . . |
416 |
|
54.3 |
What Systemic Medications Must Narrow Angle Patients |
|
|
|
Be Counseled Against Using? Is It Safe to Use These |
|
|
|
Medications If There Is a Patent LPI? . . . . . . . . . . . |
417 |
|
References . . . . . . . . . . . . . . . . . . . . . . . . . |
418 |
|
55 |
Angle-Closure Glaucoma: Iridotomy . . . . . . . . . . . . . |
421 |
|
|
55.1 |
What Settings Should Be Used to Perform Laser |
|
|
|
Peripheral Iridotomy (LPI)? . . . . . . . . . . . . . . . |
421 |
Contents |
xxi |
|
|
55.2How Does Iris Color Affect the Laser Settings? . . . . . . . . 422
55.3If It Is Difficult to Penetrate the Iris, What Adjustments
|
Can Be Made to the Laser Settings? . . . . . . . . . . . . |
422 |
55.4 |
What Potential Complications Should Be Anticipated with Laser |
|
|
Peripheral Iridotomy and How Should Each One Be Managed? . |
423 |
55.5 |
Under What Circumstances Is Surgical Iridectomy Indicated? |
|
|
How Should a Surgical Iridectomy Be Performed? . . . . . . |
424 |
References . . . . . . . . . . . . . . . . . . . . . . . . . |
425 |
|
56 Angle-Closure Glaucoma: Imaging . . . . . . . . . . . . . . |
427 |
|
56.1Is New Imaging Technology Useful in Angle Examination? . . . 427
56.2What Imaging Devices Are Currently Available to Examine
the Anterior Chamber Angle? . . . . . . . . . . . . . . . 428
56.3When Should UBM and AS-OCT Be Ordered: Is One Device Considered Better than the Other? . . . . . . . . . . . . . 430
56.4How Should Test Results Be Interpreted and Used
|
to Help Treat the Patient? . . . . . . . . . . . . . . . . |
430 |
References . . . . . . . . . . . . . . . . . . . . . . . . . |
433 |
|
57 Angle-Closure Glaucoma: Medical Therapy . . . . . . . . . . |
435 |
|
57.1 |
During an Acute Angle-Closure Attack, What Medications |
|
|
Are Indicated? . . . . . . . . . . . . . . . . . . . . . |
435 |
57.2 |
Should Pilocarpine Be Avoided in Angle-Closure Patients? . . . |
436 |
References . . . . . . . . . . . . . . . . . . . . . . . . . |
437 |
|
58 Angle-Closure Glaucoma: Surgical Management |
|
|
of Acute Angle-Closure Glaucoma . . . . . . . . . . . . . . |
439 |
|
58.1 |
What Is the Role of Paracentesis in the Management |
|
|
of Acute Angle-Closure Glaucoma? Technically, How Should |
|
|
this Be Performed If the Anterior Chamber Is Very Shallow? . . |
439 |
58.2 |
Is There a Role for Cataract Extraction in Acute Angle-Closure? |
|
|
If Cataract Surgery Must Be Performed Under Conditions |
|
|
of Acute Angle-Closure, What Can Be Done to Ensure |
|
|
the Best Possible Outcome for the Patient? . . . . . . . . . |
440 |
58.3How Should Angle-Closure Due to Phacomorphic Glaucoma
or Loose Zonules Be Managed? . . . . . . . . . . . . . . 441
58.4In Routine Cataract Surgery Where the Patient Has an Occludable Angle, Should LPI Be Performed Before Cataract Extraction
|
or Can One Proceed Directly to Cataract Surgery? . . . . . . |
442 |
References . . . . . . . . . . . . . . . . . . . . . . . . . |
443 |
|
59 Complications: Hypotony . . . . . . . . . . . . . . . . . . |
445 |
|
59.1 |
What are the Options in the Treatment of Early |
|
|
Postoperative Hypotony? . . . . . . . . . . . . . . . . |
445 |
59.2 |
If There Is Hypotony Maculopathy, What Should Be |
|
|
Done to Manage It? . . . . . . . . . . . . . . . . . . . |
447 |
59.3 |
How Can I Manage Late Hypotony Due to a Scleral Melt? . . . |
448 |
59.4 |
Which Patients Are at Risk for Hypotony? . . . . . . . . . . |
448 |
References . . . . . . . . . . . . . . . . . . . . . . . . . |
448 |
|
xxii |
|
|
Contents |
|
|
|
|
60 |
Complications: Bleb Leaks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
449 |
|
|
60.1 |
Does an Early Bleb Leak Need to Be Fixed? . . . . . . . . . |
449 |
|
60.2 |
How Should I Treat a Late-Onset Bleb Leak? . . . . . . . . |
451 |
|
60.3 |
What Can I Do to Decrease the Chances of a Future Bleb Leak? . |
454 |
|
References . . . . . . . . . . . . . . . . . . . . . . . . . |
454 |
|
61 |
Complications: Blebitis . . . . . . . . . . . . . . . . . . . |
457 |
|
|
61.1 |
What Topical Antibiotics Should I Use in Blebitis? . . . . . . |
457 |
|
61.2 |
When Should I Move on to Intravitreal Injections? . . . . . . |
458 |
|
61.3 |
How Do I Manage a Patient After the Blebitis Is Resolved? . . . |
458 |
|
References . . . . . . . . . . . . . . . . . . . . . . . . . |
459 |
|
Contributors
Luciana M. Alencar Hamilton Glaucoma Center, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0946, USA
Douglas R. Anderson Bascom Palmer Eye Institute,
University of Miami, Miller School of Medicine, Clinical Research Building (LOC C-209), 1120 NW 14 Street, Miami, FL 33136-2107, USA
Tin Aung Singapore Eye Research Institute, Singapore National Eye Center, 11 Third Hospital Avenue, Singapore
Allen Beck Emory University, 1365-B Clifton Road NE, Atlanta, GA 30322, USA
Francesca Bertuzzi Clinica Oculistica del Policlinico di Monza, Università Milano-Bicocca, Via Amati 111, 20052, Monza (MI), Italy
James D. Brandt Department of Ophthalmology & Vision Science, University of California, Davis, 4860 Y Street, Suite 2400, Sacramento, CA 95917-2307, USA
Claude F. Burgoyne Optic Nerve Head Research Laboratory, Discoveries in Sight Research Laboratories, Devers Eye Institute, 1225 NE 2nd Avenue, Portland, OR 97232, USA
Yvonne M. Buys Department of Ophthalmology and Visual Sciences, University of Toronto, Toronto, ON, Canada and
Department of Ophthalmology, Toronto Western Hospital, Toronto, ON, Canada
Joseph Caprioli Jules Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
Balwantray C. Chauhan Department of Ophthalmology and Visual Sciences, Eye Care Centre, Centennial Building, 1278 Tower Road, Halifax, Nova Scotia, Canada B3H 3L9
Philip P. Chen Department of Ophthalmology, University of Washington Medical Center, Box 356485, Seattle, WA 98195, USA
Teresa C. Chen Department of Ophthalmology, Harvard Medical School, Boston, MA, USA and
Massachusetts Eye and Ear Infirmary, Glaucoma Service, 243 Charles Street, Boston, MA, USA
xxiii
xxiv |
Contributors |
|
|
Howard Cohn Ophthalmology Center of Trocadero, 45 Rue Vineuse,
Paris 75016, France
Anne L. Coleman Jules Stein Eye Institute, David Geffen School of Medicine, University of California at Los Angeles, 100 Stein Plaza, Los Angeles, CA 90095, USA
Greet Coppens Department of Ophthalmology, University UZ Leuven,
Kapucijnenvoer 33, 3000 Leuven, Belgium
Amish B. Doshi Hamilton Glaucoma Center, University of California San Diego,
La Jolla, CA, USA
David Dueker Department of Ophthalmology, Medical College of Wisconsin,
The Eye Institute, 925 N 87th Street, Milwaukee, WI 53226, USA
Beth Edmunds Casey Eye Institute, Oregon Health and Science University, 3303 SW Bond Avenue, Portland, OR 97239, USA
Rita Ehrlich Department of Ophthalmology, Indiana University,
702 Rotary Circle, Indianapolis, IN 46202-5175, USA
Héctor Javier Fontana Hospital Oftalmológico Santa Lucía, San Juan 2021,
Ciudad Autónoma de Buenos Aires, República Argentina
Brian A. Francis Doheny Eye Institute, Keck School of Medicine,
University of Southern California, 1450 San Pablo Street, DEI 4804,
Los Angeles, CA 90033, USA
David F. Garway-Heath Glaucoma Research Unit, NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, 162 City Road, London EC1V 2PD, UK
Jian Ge Zhongshan Ophthalmic Center, Sun Yat-Sen University,
54S. Xianlie Road, Guangzhou, 510060, People’s Republic of China
JoAnn A. Giaconi Jules Stein Eye Institute, David Geffen School of Medicine,
University of California at Los Angeles, 100 Stein Plaza, Los Angeles,
CA 90095, USA
Veterans Health Administration of Greater Las Angeles, 11301 Wilshire Blvd,
Los Angeles, CA, USA
Annette Giangiacomo Emory University, 1365B Clifton Road, Room 6161
Atlanta, GA 30329
David S. Greenfield Bascom Palmer Eye Institute,
University of Miami Miller School of Medicine, 7101 Fairway Drive,
Palm Beach Gardens, FL 33418, USA
Alon Harris Department of Ophthalmology, Indiana University, 702 Rotary Circle, Indianapolis, IN 46202-5175, USA
Mingguang He Zhongshan Ophthalmic Center, Sun Yat-sen University,
Guangzhou 510060, People’s Republic of China
Leon W. Herndon Duke University Eye Center, Box 3802 DUMC, Durham,
NC 27710, USA
Contributors |
xxv |
|
|
Donald C. Hood Department of Psychology, Columbia University,
1190 Amsterdam Ave. MC5501, New York, NY 10027, USA
Chris Hudson Department of Ophthalmology and Visual Sciences, University of
Toronto, Toronto, ON, Canada
School of Optometry, University of Waterloo, Waterloo, ON, Canada
Annisa L. Jamil Glaucoma Consultants Northwest, Arnold Medical Pavilion, 1221 Madison Street, Suite 1124, Seattle, WA 98104, USA
Chris A. Johnson Department of Ophthalmology and Visual Sciences,
University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City,
IA 52242 -1091, USA
Malik Y. Kahook University of Colorado Denver,
Rocky Mountain Lions Eye Institute, 1675 N. Ursula Street, Aurora,
CO 80045, USA
Kenji Kashiwagi Department of Ophthalmology, University of Yamanashi,
Chuo, Yamanashi, Japan
Peng Tee Khaw National Institute for Health Centre,
Moorfields Eye Hospital and UCL Institute of Ophthalmology, 11-43, Bath Street,
London EC1V 9EL, UK
Nisha S. Kheradiya Department of Ophthalmology, Indiana University,
702 Rotary Circle, Indianapolis, IN 46202-5175, USA
Yoshiaki Kitazawa Akasaka Kitazawa Eye Clinic, Akasaka Syuzann Building 5F, 5-5-13, Akasaka, Minato-ku, Tokyo, 107-0052, Japan
Rajesh S. Kumar Singapore Eye Research Institute, Singapore National
Eye Center, 11 Third Hospital Avenue, Singapore
Young H. Kwon Department of Ophthalmology & Visual Sciences,
University of Iowa Health Care, 200 Hawkins Drive, Iowa City, IA 52242, USA
Simon K. Law Jules Stein Eye Institute, David Geffen School of Medicine,
University of California, 100 Stein Plaza, 2-235, Los Angeles, CA 90095, USA
Paul P. Lee Duke University Eye Center, Albert Eye Research Institute,
Erwin Road, Durham, NC 27710, USA
Richard K. Lee Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th Street, Miami, FL 33136, USA
Richard A. Lewis Private Practice Sacramento, California, USA
Shan C. Lin University of California, San Francisco Medical School,
10 Koret Way, San Francisco, CA 94143-0730, USA
Steven L. Mansberger Devers Eye Institute/Discoveries in Sight,
Legacy Health System, 1040 NW 22nd Avenue, Suite 200, Portland,
OR 97210, USA
Lionel A. Marzette Duke University Eye Center, Box 3802 DUMC, Durham,
NC 27710, USA
xxvi |
Contributors |
|
|
Eugenio Maul Department of Ophthalmology, School of Medicine,
Pontificia Universidad Catolica, Ave. Apoquindo 3990 Suite 708, Santiago, Chile
Hylton R. Mayer Department of Ophthalmology and Visual Sciences,
Yale University School of Medicine, New Haven, CT 06517, USA
Felipe A. Medeiros Hamilton Glaucoma Center, University of California,
San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0946, USA
Stefano Miglior Clinica Oculistica del Policlinico di Monza,
Università Milano-Bicocca, Via Amati 111, 20052, Monza (MI), Italy
Don Minckler University of California, 118 Med Surge I, Irvine, CA 92697-4375, USA
Richard P. Mills Glaucoma Consultants Northwest, Arnold Medical Pavilion, 1221 Madison Street, Suite 1124, Seattle, WA 98104, USA
John C. Morrison Casey Eye Institute, Oregon Health and Science University, 3303 SW Bond Avenue, Portland, OR 97239, USA
Marlene R. Moster Thomas Jefferson University School of Medicine,
Wills Eye Institute, 840 Walnut Street, Philadelphia, PA 19107, USA
Marcelo T. Nicolela Department of Ophthalmology and Visual Sciences,
Dalhousie University, Eye Care Centre, 1278 Tower Road, Halifax, Nova Scotia,
Canada B3H 2Y9
Kouros Nouri-Mahdavi Shiley Eye Center, 9415 Campus Point Drive, La Jolla,
CA 92093, USA
Louis R. Pasquale Department of Ophthalmology, Massachusetts Eye and Ear
Infirmary, 243 Charles Street, Boston, MA 02114, USA and
Harvard Medical School, Boston, MA, USA
Rony Rachmiel Department of Ophthalmology, Toronto Western Hospital, 399 Bathurst Street, New East Wing 6-405, Toronto, ON, Canada M5T 2S8 and
Department of Ophthalmology and Visual Sciences, University of Toronto, Toronto, ON, Canada
Ehud Rechtman Goldschleger Eye Institute, Sheba Medical Center,
Tel-Hashomer 52621, Israel
Thomas Ressiniotis Moorfields Eye Hospital and UCL Institute of
Ophthalmology, 11-43, Bath Street, London EC1V 9EL, UK
Douglas J. Rhee Harvard Medical School, 243 Charles Street, Boston, MA 02114, USA and Massachusetts Eye & Ear Infirmary Children’s Hospital, Boston, MA, USA
Robert Ritch The New York Eye and Ear Infirmary, 310 East 14th Street,
New York, NY 10003, USA
Alan L. Robin Wilmer Eye Institute, Johns Hopkins Hospital, 600 N Wolfe Street, Wilmer B20, Baltimore, MD 21287-5001, USA, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA, and University of Maryland, 6115 Falls Road, Suite 333, Baltimore,
MD 21209-2226, USA
Contributors |
xxvii |
|
|
Jim Robinson Department of Ophthalmology, Medical College of Wisconsin,
The Eye Institute, 925 N 87th Street, Milwaukee, WI 53226, USA
Joel S. Schuman University of Pittsburgh School of Medicine, Pittsburgh, PA, USA, and Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA
Clinton W. Sheets Bascom Palmer Eye Institute, University of Miami
Miller School of Medicine, 7101 Fairway Drive, Palm Beach Gardens, FL 33418, USA
M. Bruce Shields Department of Ophthalmology and Visual Sciences,
Yale University School of Medicine, New Haven, CT 06517, USA
Lesya Shuba Department of Ophthalmology and Visual Sciences,
Dalhousie University, 2 West, 1278 Tower Road, Halifax, Nova Scotia,
Canada B3H 2Y9
Arthur J. Sit Mayo Clinic College of Medicine, 200 First Street SW, Rochester,
MN 55905, USA
Carlos Souza Ophthalmology Department, Federal University of Sao Paulo,
Sao Paulo, Brazil
Robert L. Stamper Department of Ophthalmology, University of California at San Francisco, 10 Koret Way, San Francisco, CA 94143, USA
Nicholas G. Strouthidis Glaucoma Research Unit, NIHR Biomedical Research
Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, and
UCL Institute of Ophthalmology, 162 City Road, London, EC1V 2PD, UK, and
Optic Nerve Head Research Laboratory, Devers Eye Institute, 1225 NE 2nd Avenue,
Portland, OR, USA
Kazuhisa Sugiyama Department of Ophthalmology, Kanazawa University Graduate School of Medical Science, 13-1 Takara-machi, Kanazawa 920-8641, Japan
Marla B. Sultan New York Eye & Ear Infirmary, New York, NY, USA
Remo Susanna Jr. University of Sao Paulo, Av. São Gualter 99,
05455 -000 São Paulo, Brazil
Kenneth C. Swan Casey Eye Institute, Oregon Health and Science University, 3303 SW Bond Avenue, Portland, OR 97239, USA
Fotis Topouzis A’ Department of Ophthalmology, Aristotle University of
Thessaloniki, AHEPA Hospital, Stilponos Kyriakidi 1, 54363, Thessaloniki, Greece
Kelly A. Townsend Department of Ophthalmology, University of Pittsburgh
School of Medicine, UPMC Eye Center, 203 Lothrop Street,
Pittsburgh, PA 15213, USA
Graham E. Trope Department of Ophthalmology and Visual Sciences,
University of Toronto, Toronto, ON, Canada, and Department of Ophthalmology,
Toronto Western Hospital, 399 Bathurst Street, New East Wing 6-405, Toronto,
ON, Canada M5T 2S8
James C. Tsai Department of Ophthalmology and Visual Sciences,
Yale University School of Medicine, New Haven, CT 06517, USA
xxviii |
Contents |
|
|
Carlos Gustavo Vasconcelos de Moraes University of Sao Paulo School of
Medicine, Rua Alves Guimaraes, Sao Paulo, Brazil
David S. Walton Massachusetts Eye and Ear Infirmary, 2 Longfellow Place, 201, Boston, MA 02114, USA, and Harvard Medical School, 243 Charles Street, Boston, MA 02114, USA
Adam S. Wenick Wilmer Eye Institute, Johns Hopkins Hospital,
600 N Wolfe Street, Wilmer B20, Baltimore, MD 21287-5001, USA
Robert N. Weinreb Hamilton Glaucoma Center, University of California, 9500 Gilman Drive, La Jolla, CA 92093, USA
Janey L. Wiggs Department of Ophthalmology, Massachusetts Eye and Ear
Infirmary, Boston, MA 02114, USA, and Harvard Medical School, 243 Charles
Street, Boston, MA 02114, USA
M. Roy Wilson University of Colorado Denver, Rocky Mountain Lions Eye
Institute, 1675 N. Ursula Street, Aurora, CO 80045, USA
Gadi Wollstein University of Pittsburgh School of Medicine, Pittsburgh, PA,
USA Ophthalmic Imaging Research Laboratories, UPMC Eye Center,
Pittsburgh, PA, USA
Kayoung Yi Department of Ophthalmology, Kangnam Sacred Heart Hospital,
College of Medicine, Hallym University, Seoul, 150-950, Korea
Thierry Zeyen Department of Ophthalmology, University UZ Leuven,
Kapucijnenvoer 33, 3000 Leuven, Belgium
Abbreviations
ACC |
Acute angle closure |
ACG |
Angle closure glaucoma |
AGIS |
Advanced Glaucoma Intervention Study |
AL |
Axial length |
ALT |
Argon laser trabeculoplasty |
APON |
Acquired pit of the optic nerve |
AUC |
Area under the receiver operating curve |
BAK |
Benzalkonium chloride |
CAI |
Carbonic anhydrase inhibitor |
CCT |
Central corneal thickness |
C/D |
Cup-to-disc ratio |
CDI |
Color Doppler imaging |
CDR |
Cup-to-disc ratio |
CH |
Corneal hysteresis |
CIGTS |
Collaborative Initial Glaucoma Treatment Study |
CLBF |
Canon laser blood flowmetry |
CNTGS |
Collaborative Normal Tension Glaucoma Study |
CSLO |
Confocal scanning laser ophthalmoscopy |
CTD |
Congenital tilted disc |
dB |
Decibels |
DCT |
Dynamic contour tonometer |
ECD |
Endothelial cell density |
ECM |
Extracellular matrix |
ECP |
Endoscopic cyclophotocoagulation |
EGPS |
European Glaucoma Prevention Study |
EMGT |
Early Manifest Glaucoma Trial |
FBCF |
Fornix based conjunctival flap |
FDT |
Frequency doubling technology perimetry |
5FU |
5-Flurouracil |
GAT |
Goldmann applanation tonometry |
GATE |
German adaptive threshold estimation |
GCP |
Glaucoma change probability |
GDD |
Glaucoma drainage device |
GDX |
Brand name of machine that performs scanning laser polarimetry |
GDX-ECC |
GDX with enhanced corneal compensation |
GDX-NFA |
GDX nerve fiber analyzer |
GDX-VCC |
GDX with variable corneal compensation |
xxix
xxx
GHT |
Glaucoma hemifield test |
GPA |
Guided Progression Analysis |
GPS |
Glaucoma Probability Score |
HRP |
High pass resolution perimetry |
HRT |
Heidelberg retinal tomography |
HFA |
Humphrey visual field analyzer |
HRF |
Heidelberg retinal flowmeter |
ICE |
Iridocorneal endothelial syndrome |
ILM |
Inner limiting membrane |
IOP |
Intraocular pressure |
ISNT |
Mneumonic for the thickest (inferior) to thinnest (temporal) |
|
neuroretinal rim |
LASIK |
Laser in situ keratomileusis |
LBCF |
Limbal based conjunctival flap |
LDF |
Laser Doppler flowmetry |
LPI |
Laser peripheral iridotomy |
LTP |
Laser trabeculoplasty |
MD |
Mean deviation |
mf ERG |
Multifocal electroretinogram |
mf VEP |
Multifocal visual evoked potential |
MMC |
Mitomycin-C |
MPHSD |
Mean pixel height standard deviation |
MRA |
Moorfield regression analysis |
MTD |
Myopic tilted disc |
NFI |
Nerve fiber index (used on GDX) |
NFL |
Nerve fiber layer |
NFLT |
Nerve fiber layer thickness |
NTG |
Normal tension glaucoma |
NV |
Neovascularization |
NVG |
Neovascular glaucoma |
OAG |
Open angle glaucoma |
OBF |
Ocular blood flow |
OCT |
Optical coherence tomography |
OHTS |
Ocular Hypertension Treatment Study |
OND |
Optic nerve drusen |
ONH |
Optic nerve head |
ONTT |
Optic Neuritis Treatment Trial |
OPA |
Ocular pulse amplitude |
OPP |
Ocular perfusion pressure |
ORA |
Ocular response analyzer |
PAS |
Peripheral anterior synechiae |
POAG |
Primary open angle glaucoma |
POBF |
Pulsatile ocular blood flowmeter |
PPA |
Peripapillary atrophy |
PSD |
Pattern standard deviation |
PXF |
Pseudoexfoliation |
RBP |
Rarebit perimetry |
RGC |
Retinal ganglion cell |
RNFL |
Retinal nerve fiber layer |
Abbreviations
Abbreviations |
xxxi |
|
|
RPE |
Retinal pigment epithelium |
RVA |
Retinal vessel analyzer |
SAP |
Standard automated perimetry |
SD |
Standard deviation |
SD-OCT |
Spectral domain optical coherence tomography (also known as |
|
Fourier domain OCT) |
SITA |
Swedish Interactive Threshold Algorithm |
SLO |
Scanning laser ophthalmoscope |
SLP |
Scanning laser polarimetry |
SLT |
Selective laser trabeculoplasty |
SWAP |
Short wavelength automated perimetry |
SWS |
Sturge Weber syndrome |
TCA |
Topographical change analysis |
TCP |
Transcleral cyclophotocoagulation |
TOP |
Tendency oriented perimetry |
TSNIT |
Temporal, superior, nasal, inferior, temporal |
VA |
Visual acuity |
VCDR |
Vertical cup to disc ratio |
VF |
Visual field |
VFI |
Visual field index |
ZEST |
Zippy estimation by sequential testing |
3D |
3-Dimensional |